A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Thursday, October 04, 2007

Question for Docs about DEA Numbers

The occasion arose today for me to call an antibiotic prescription (ie, not a controlled substance) in to a pharmacy in another state for a vacationing patient. It was a chain store, but because they didn't have a national database I was asked to provide my DEA number along with my address and phone number.

I'm used to this by now. I understand that many insurance companies use the DEA as a unique physician identifier and so require them even for prescriptions of non-controlled substances. But it still bugs me on principle. (ie, How can I be sure that some pharmacist or tech won't swipe it to forge controlled prescriptions?)

I was feeling polite today, so all I said was, "Ok, let's just pretend I threw a hissy fit," before rattling off the number. But then the pharmacist surprised me by saying, "You know, we get docs from all fifty states calling things in here, and the only ones who have any problem giving us their DEA numbers are the docs from Pennsylvania."

WTF?

So let me throw this out there: Are PA docs the only ones:

concerned about drug diversion?

paranoid about unauthorized use of our DEA numbers?

insufficiently trusting of our pharmacy colleagues?

Do docs in other states not care about these things? Are we (Pennsylvanians) being overly cautious?

Or was this pharmacist just jerking my chain? That is, are there plenty of docs in other states also decrying the requirement to divulge their DEAs so promiscuously?

HI - this reminds me of how not so long ago our social security numbers were used as unique identifiers on everything... including my HMO id number. Our cards were printed with the number. But now we go to great lengths to avoid throwing that around -for good reason! I would think a DEA number would have similar cautions. Time for insurance companies to use something else as unique identifiers, for pete's sake! Hope you enjoyed your time off. I missed you!

I haven't complained once, and I've practie in both Pa and NY. I always thought the DEA question was to verify who we are, though it's on all our scripts so it's not like it's top secret or anything....

I have never obtained a DEA number, and never intend to obtain one, as I never write scripts for scheduled drugs. EVER. Why would I want the bother and hassle of audits and expense and whatnot it I ain't gonna use it.

I've never been asked for a DEA number when calling in a script. Considering the risks to you, the doctor, I wouldn't use it as a unique identifier either.

You think the pharmacy not having your specific DEA number is going to stop someone at that store from forging a script?

Hah! Forging a prescription isn't rocket science. Any "doctor's representative" can call in a prescription even if they were hired that morning. How ridiculous is that? How do I know your office staff isn't faking prescriptions? It's the same idea.* And frankly:

2) If I wanted some controlled medications, I wouldn't bother forging a script. I'd just take the pills and be done with it.

I've only ever come across one doctor who objected to giving out their DEA number while phoning in a prescription. I wanted to drive to the office and put my foot up his fucking ass.

He gave it to me, of course. The reason I ask for it is completeness of records. The same reason I'll ask for your fax and telephone numbers and your address while I have you on the line. I'm entering it so no one else in my chain will ever have to chase you down for that info later, regardless of where they're located.

I'm doing you a favor by doing this. Now shut up and play along. I'm not going to pick an out-of-town doctor that calls in a one-off script to my pharmacy. That would be mind-numbingly dumb. You'd pick a doctor that calls in dozens of scripts per day, because there's nothing unusual about that. Probably an orthopedist or someone in a similar line of work.

* More irony enters the picture when you realize that *anyone* can be a "doctor's representative" while in the state of NH, only a pharmacist or intern can take the prescription at the other end. In MA, you have to be a pharmacist, intern, or nationally-certified pharmacy tech. Where's the certification for the people on the other end of the phone? How do I know they're getting it right?

Since we got electronic prescribing, I can tell you how often the pharmacist really did make the mistake. Whereas, in the past I would say "maybe I forgot to write the refill number", now I can say "I am looking at the original electronic Rx and it says 6 refills so please don't call me back til November!"

The number of errors is stunning.

Of course, it's not a slight to all pharmacists, just the ones oin my neighborhood. Physicians and pharmacists depend on each other, but if you want, use your own darn number.

Electronic prescribing doesn't get rid of all of the errors on the doctor's end, either. We still see gibberish spit out of the printer, too.

My anecdote cancels your anecdote. Nyah. :P

(And FWIW, many prescriptions are generated off of the old ones, which by default sets the number of allowed refills to zero, and stays that way unless the tech goes back and alters it.)

I think in my six years behind the counter, I've come across maybe six instances where an office rang us to ask if we'd put the correct number of refills on there. Some pharmacists are better than others, as with all professions.

For absolutely real, honest-to-goodness e-prescribing, this is a non-issue, because the script is generated and all the fields are automatically filled out, all one needs to do is stick a pick-up time on it. Systems that can do that are few and far between, however. I'd say maybe 5% of all electronic prescriptions.

Hello, dino. I completely agree about the DEA numbers. We've had patients call posing as pharmacists trying to get our numbers. We always ask which pharmacy's calling and then call them back to make sure it's actually them. A PA (physician's assistant, not a "whiner" from PA:) I work with had her number get out among a group of people in the city and has been having scripts called in in her name all over. She's called all the local pharmacies to let them know that if any narc scripts are called in in her name, they have to call the clinic to confirm. So, I think you do have to be a little careful with your number.

RJS: My social security number, birth date, place of birth, license plate number along with my car make and model, not to mention my height and weight, could also be requested under the rubric of "completeness."

The issue is that of reserving the dissemination of sensitive information for "need to know" contexts only. ie, If you're going to pay me income then you need my social security number; if not, then it's NOYB. When (if) I call in a controlled substance, then I'll gladly give you my DEA. (My office policy is to allow staff to call in only non-controlled substance Rxs.) Honest people will never be tempted, but why take chances when you don't have to?

All the verifications are just as much a pain in the ass for the pharmacists as they are for the docs. The pharmacists are just doing their jobs and jumping through all of the hoops that are imposed upon them, so I try to cut them a break. Most are just as overworked and underpaid as we are. If I get called by a pharmacist I don't know asking for my DEA, I will ask them a medication-related question just to verify that they are at least in the medical field. "What's Lasix used for?" or "What's the trade name for cephalexin?" Quite a few times, the caller has hung up. Maybe I caught a real pharmacist off guard or maybe it wasn't really a pharmacist. At least I get a grin about the "gotcha" moment. If I suspect that a patient might be drug seeking, I won't put my DEA on the script, but will write "call ER."Will all of this keep patients from using my DEA illegally? Probably not. Avoiding asking someone in downtown Harlem if they have change for a $100 bill won't keep me from getting robbed, either, but it sure cuts down on the risk.You're right to be paranoid, but you can always have a little fun while you're at it (before they get you).

I have fought this request for years. I always refuse to give out my DEA number, instead offering my state license number. Unfortunately, this doesn't work in their computers because license numbers in different states have different configurations and numbers of fields. The DEA numbers were used because every doctor in the country has an identifier with two letters and seven numbers. However, that's not my problem, and that's not how the DEA numbers were intended to be used. I complained to the Board of Pharmacy in my state, and eventually the local pharmacies were prohibited from demanding DEA numbers for non-controlled prescriptions. However, so many patients now use out of state mail order pharmacies that my efforts now seem insignificant. They tell the patient that they can't fill the prescription because the doctor wouldn't give them the information they want. That makes the doctor the bad guy.

"They tell the patient that they can't fill the prescription because the doctor wouldn't give them the information they want. That makes the doctor the bad guy."

I don't tell them that - I tell them the truth, which #1 dino mentioned in the post - that the insurance company won't pay for it without the DEA. We can still fill the prescription as cash. This of course is not satisfactory to patients. WE come across as the bad guys too. In reality, it's the insurance companies that are being the pains in the patient's backside... but they're not standing across the counter from the insurance company, now are they?

Personally, I hate having to call a doctor to ask for their DEA for a levaquin script. It's ridiculous and it should be unnecessary, but unfortunately it's not. I may be naive and idealistic, but I don't see any need for doctors to get mad at pharmacies for trying to do their jobs. Do what you have to do to protect your number - get a phone number and call back, or ask questions like stated above. Otherwise, there ARE going to be patients who call and say we wouldn't give them the meds, even though any tech or pharmacist worth their salt would explain how it's the insurance company that's balking.

I'm getting a real runaround from the pharmacy service in my new insurance plan. I've tried several times to ask them if a new specialist I'm going to see is in their network database. I finally found a phone rep who would look, but the first info he asked for is "What is the doctor's DEA number?" I said I had no idea. Evidently, they use DEA numbers to uniquely identify doctors, and will not look consider any other info.

I've also started having health insurer's ask for my Soc.Sec number when I call them, though they can't give me a reason why they are asking for it. I've gone so far as to ask what federal or state regulation requires them to ask for my S.S. number, but didn't get very far with this.

"RJS: My social security number, birth date, place of birth, license plate number along with my car make and model, not to mention my height and weight, could also be requested under the rubric of "completeness.""

Not for my purposes. For someone else's, maybe. A DEA number is an integral piece of information when it comes to prescribing medications. Fax and telephone numbers are secondary, but also important. I don't see the comparison, but I think you're just being snarky, yes? :)

I have fought this request for years. I always refuse to give out my DEA number, instead offering my state license number. Unfortunately, this doesn't work in their computers because license numbers in different states have different configurations and numbers of fields. The DEA numbers were used because every doctor in the country has an identifier with two letters and seven numbers. However, that's not my problem, and that's not how the DEA numbers were intended to be used. I complained to the Board of Pharmacy in my state, and eventually the local pharmacies were prohibited from demanding DEA numbers for non-controlled prescriptions. However, so many patients now use out of state mail order pharmacies that my efforts now seem insignificant. They tell the patient that they can't fill the prescription because the doctor wouldn't give them the information they want. That makes the doctor the bad guy.

Good luck with that. Might as well try to push water uphill. And you're the bad guy because you won't give out your DEA # -- which is a reasonable request from certain parties -- and because people can walk into your office and complain at you. Happens to us, too.

It's much harder to walk into a mail order pharmacy and complain about bad service, now isn't it?

(Double hate for mail order houses when they tell them to call a retail pharmacy nearby when they have a drug question. Eat a bag of hell, assholes.)

Anyway, pick and choose your battles. I don't think the DEA # is one worth fighting, since it's a matter of public record anyway. (Yeah, it's a pain in the ass to look up, but it can be done.)

Maybe docs in other states are just more conditioned...what are the billing requirements in other states?But I always feel the same way phoning in refill requests to Drs who's scripts we don't see often...How do they know who I am when I phone in a refill request?And why, oh why, do doctors refuse to take fax?

rjm this tech is pining for e prescribing the writing is bad enough but the faxes are worse

28 year old med student again (also a pharmacist). Understand it from a pharmacist's perspective. You have a patient you have never seen and you need to get a rx from a physician you have never heard of. What's to stop anybody (RPh, patient, medical office staff) from simply stealing your DEA off of you prescription pad and using it? How is that any different from phoning in an rx with your DEA? It is not some insurance companies, all insurance companies require a valid DEA to accompany the prescription. IF the rx is 250.00 vs 15.00 on insurance, you are not the ones who get yelled at, the pharmacist is. Also, asking for a DEA is a good way to verify that the person you're actually talking to is indeed a physician. If they can recite the DEA quickly and by memory, you know it is more likely legit (a lot of people faking prescriptions get confused when asked to provide a dea over the phone).Finally, many states require the pharmacist to obtain a DEA when receiving a controlled drug from a physician.Your hissy fit accomplishes nothing. Think, before you chew out your RPh. Other than that, I like your blog an awful lot.

I lot of people seem to be losing sight of the fact that my beef is with providing my DEA for prescriptions for drugs that are NOT CONTROLLED SUBSTANCES. I have no problem providing my number whenever I do call in a controlled script. In fact, I expect to be asked for it each time I do so, so there isn't even any actual "need" to "keep it on file."

I am well aware that it is the insurance companies inappropriately appropriating the DEA registration as a unique provider identifier and that you pharmacists are caught in the middle. I understand that you share my frustrations with the situation, and I appreciate your allowing me to vent PRN.

Hi! I read the NYT article on "Dr Drug Rep" which was the first time I had heard about the AMA selling DEA numbers that are used by drug companies etc. to track prescribing habits. Does anyone have reliable sources on this information? Cheers

Unforunately the DEA number is not a secret at all, so isn't going to stop potential abuse

Well apparently the ama or some database collector is selling dea numbers as there are several services just online that you can subscribe to that you can cross reference by doctor name, location, etc not to metion data sservices selling directly to pharmacies.

So basically anyone could look up your DEA number if they want...not to mention with a few extra key strokes the rest of your data. All in the name of doctor verification it somehow got backwards.

Lets face it the whole system is screwed up, drug seeking patients causing doctors to be afraid to prescribe certian meds at all, due to potential liability, insurance companies screwing doctors and pharmacists alike, not to mention making more issues by requiring DEA numbers, data services selling every bit of data they can for find for cash to whomever asks for it on both doctors and patients(...take a look at the new med-fico) even with HIPAA. All the while all medical staffers have free rain in most places.

Medical techology in itself may be a great thing, but the modern world is a bad place. Things sound like they were so much more honest 25-50 years ago...and at least certainly a lot easier to deal with.

From the DEA.....the pharmacist is WRONG!DEA strongly opposes the use of a DEA registration number for any purpose other than the one for which it was intended, to provide certification of DEA registration in transactions involving controlled substances. The use of DEA registration numbers as an identification number is not an appropriate use and could lead to a weakening of the registration system. Although DEA has repeatedly made its position known to industries such as insurance providers and pharmacy benefit managers, there is currently no legal basis for DEA to prevent or preclude companies from requiring or requesting a practitioner’s DEA registration number.